Keywords
counseling - knowledge - partner
Physicians and other medical providers counsel patients to provide them with most
important information and available medical service options. During antenatal period,
the ideal counseling focuses on the several obstetric issues regarding the pregnant
person and their fetus.[1] In Thailand, the content of antenatal counseling commonly includes the ultrasound
screening of the fetus at various stages, trisomy-21 screening or diagnosis, thalassemia
carrier screening, appropriate nutritional intake, lifestyle for good maternal and
fetal health, and how to prepare for the delivery. Pregnant women in Thailand receive
antenatal care from a variety of medical providers and in settings ranging from community
health center or clinic to tertiary hospital. Thalassemia screening has generally
been implemented as a national policy aiming to reduce and prevent maternal and neonatal
mortality and morbidity. Nearly all pregnant individuals are screened for thalassemia
carrier status and have their fetus assessed for risk of severe thalassemia including
homozygous beta thalassemia, beta-E thalassemia disease, and homozygous alpha-1 disease.
The effectiveness of thalassemia screening and morbidity and mortality prevention
depend on the gestational age at the first antenatal care visit. The Thai government
encourages pregnant individuals to access antenatal care before 12 weeks of gestation.
At present, pregnant individuals mainly receive antenatal care knowledge from an antenatal
booklet that they receive during the first antenatal visit. For aneuploidy screening,
there is no definite guideline. The Royal Thai College of Obstetrics and Gynecologists
recommends offering aneuploidy screening to all pregnant individuals. For resource-limited
settings, biochemical screening is mainly available, whereas noninvasive prenatal
testing is easily accessible in private hospitals or in urban areas. How to provide
the most effective antenatal counseling is an important focus among experts. Such
counseling can be done one-to-one, in groups, online, and via leaflets, and it involves
doctors specializing in maternal fetal medicine, general obstetricians, general practitioners,
and/or midwives. Of course, pregnant individuals have different levels of education,
family income, and medical awareness, along with various religious affiliations, or
perhaps none at all. Our previous study found that both computer-assisted instruction
and distributing leaflets are effective counseling methods in terms of improving the
parents' knowledge and satisfaction regarding genetic testing process as well as reducing
anxiety before the second-trimester genetic amniocentesis.[2]
The present study focuses on the influence of the partner's involvement during antenatal
genetic group counseling (AGGC). A previous study from Myanmar reported that the majority
of antenatal decision-making was influenced by the husband.[3] The influence of the partner's involvement on the pregnant individuals' level of
knowledge after antenatal counseling has not previously been evaluated in Thailand.
Our study was conducted to precisely assess this factor. The primary objective was
to compare the ratio of pregnant individuals with increased knowledge of key medical
issues when the partner was involved in the counseling. The second objective was to
identify other possible factors affecting the increased scores. The third goal was
to present the scores in published form.
Materials and Methods
This prospective cohort observational study was conducted among pregnant individuals
who were scheduled for AGGC within 1 to 2 weeks after the first visit at the Antenatal
Outpatient Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot
University in Nakornnayok, Thailand, between May and December 2021. Our AGGC was routinely
provided for all pregnant individuals every Friday. Pregnant individuals attended
AGGC with or without their partner depending on their convenience. Exclusion criteria
were fetal malformation detected before the AGGC, pregnant individuals who could not
read or write Thai, and pregnant individuals who declined participation. The study
was approved by the institute's Ethics Committee (approval number: SWUEC/E-471/2563)
and was registered with the Thai Clinical Trials Registry (TCTR; registration number:
20210324002). Consent was obtained from all participants. During AGGC, the pregnant
individuals who attended the AGCC with their partner could discuss with their partner
as they wished. Before AGGC started, all received a self-administrated questionnaire
and were asked to complete that questionnaire by themselves without partner consultation
twice—prior to and immediately after attending the AGGC—which was conducted face-to-face
in group sessions using PowerPoint.
The questionnaire consisted of five items. Each item consisted of 10 true-or-false
questions (total score = 50) that were described as follows: (1) general knowledge
focused on general obstetric health care such as nutrition, exercise, vaccinations,
bowel health, sexual intercourse, sleep, and relaxation; (2) ultrasound knowledge
focused on information about antenatal ultrasonographic examinations, including fetal
structural abnormality detection rate, accuracy, limitations, and safety; (3) trisomy-21
knowledge focused on various methods of prenatal trisomy-21 screening and diagnosis,
such as the individual trisomy-21 risk of each individual, the screening and diagnostic–procedures
options, the limitations of the screening test, and any diagnostic, procedures-related
risks; (4) regarding thalassemia, we focused on basic knowledge of this disease, the
carrier incidence in Thailand, the screening and diagnostic processes, and the adverse
pregnancy outcomes if a fetus is affected by severe thalassemia disease; and (5) delivery
knowledge focused on the mode of delivery and associated risks and benefits, including
immediate and long-term risks of cesarean section. Finally, the visual analogue scales
were examined to subjectively demonstrate the level of the participant's attitudes
and the level of cost-effectiveness perception regarding the usefulness of attending
AGGC at the last part of questionnaire. Our questionnaire was created by our researchers'
team specifically for this study. The validity of the questionnaire was evaluated
by six Maternal Fetal Medicine staff experts in the Department of Obstetrics and Gynecology,
Faculty of Medicine, Srinakharinwirot University. The content validity was calculated
as 96%. Using Cronbach's alpha coefficient, the reliability of the questionnaire was
calculated from a pilot study with 30 volunteers at 0.80. The difficulty and discrimination
were calculated as 0.7 and 0.26, respectively. The content of the slides and the counseling
scriptwere created by the Maternal Fetal Medicine staff at the Department of Obstetrics
and Gynecology, Faculty of Medicine, Srinakharinwirot University. The information
that corresponding to the questionnaire was included in the presentation. Each AGGC
took approximately 30 minutes with the same script with same topic presentation sequence
(general knowledge, ultrasound knowledge, trisomy-21 knowledge, thalassemic knowledge,
and delivery knowledge, respectively). The AGGC was conducted by a second-year resident
(T.A.) in the Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot
University, under the Royal Thai College of Obstetricians and Gynecologists' curriculum.
The standardized presentation was developed by the team of the Maternal Fetal Medicine
staff at the Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot
University. Everyone in the AGGC was given the opportunity to ask questions at the
end of the counseling session. The participants' demographic data and possible factors
influencing knowledge of key medical factors were collected, including maternal age,
occupation, race, religion, education, gravida, parity, history of abortion, history
of receiving information about genetic or antenatal care (previous attendance in genetic
or antenatal counseling or reading relevant information by themselves), history of
receiving preconceptional health service (laboratory testing or folic supplements),
and history of child with anomalies or genetic disease.
The required sample size was estimated by using the two independent means formula
of overall knowledge score in each group, with the expectation that the participants
had attended the AGGC either with or without their partner at an equal 1:1 ratio.
From a pilot study, we found that the mean overall knowledge scores among those who
attended the AGGC with or without their partner were 29.13 and 30.46, respectively.
The standard deviations for the overall knowledge scores of those who attended the
AGCC with or without their partner were 5.04 and 5.68, respectively. To achieve an
alpha of 0.05, a beta of 0.20, and allowing for 5% lost or missing data, it was determined
that at least 538 participants were required.
The demographic and clinical characteristics of the patients within each group were
examined by tabulating the percentages or medians and interquartile range and comparing
the differences between both groups by using the Mann–Whitney U-and chi-square tests. Changes in their overall knowledge scores were categorized
into increased or no increase, according to the differences in those scores prior
to and immediately after the AGCC. An increase was defined as the difference in the
overall knowledge score, prior to and immediately after the AGCC, being more than
or equal to 1, whereas no increase was defined as the difference between the overall
knowledge score, prior to and immediately after the AGCC as being less than or equal
to 0. The ratio of the participants who had a score increase or no increase were compared
using the chi-square test according to their demographic data, including if they had
attended the AGCC either with or without their partner. We used logistic regression
analysis to identify possible factors behind the score improvements to estimate the
odds ratios (ORs) and their 95% confidence intervals (CIs). All possible predictive
variables were initially included. Possible predictive variables identified from p-value of <0.25 in univariate analysis. A p-value of <0.05 in multiple logistic regression analysis was considered statistically
significant. Finally, we used Wilcoxon's signed-rank test to compare the knowledge
score before and after AGGC, according to group with and without partner's involvement.
A p-value < 0.05 was considered statistically significant.
Results
A total of 553 pregnant individuals were enrolled; 310 and 243 participants attended
the AGGC without or with their partner, respectively. All enrolled participants completed
the questionnaire twice: prior to and immediately after attending the AGGC. All participants
who attended without a partner had a partner, but they were unavailable to attend
AGGC. The participants' demographic and clinical data were similar in the two groups,
except for the gestational age when they attended the AGGC ([Table 1]). Participants in the AGGC without a partner attended at a gestational age significantly
earlier than those who were with their partner. The medians (Q1–Q3) of the overall
knowledge scores before and after the AGGC were 32 (29–36) and 36 (31–39) in the AGGC
with their partner, respectively, and 33 (30–36) and 35 (32–39) in the AGGC without
their partner, respectively.
Table 1
Patients' demographic characteristics (n = 553)
|
Characteristics
|
Without partner's involvement (n = 310)
|
With
partner's involvement (n = 243)
|
Total
(n = 553)
|
p-Value
|
|
Age (y), median (Q1–Q3)
|
28 (25–33)
|
28(24–32.5)
|
|
0.625[b]
|
|
Religion, n (%)
|
|
|
|
0.023[a]
|
|
• Buddhist
|
251 (58.6)
|
177 (41.4)
|
428 (100)
|
|
|
• Muslim and others
|
59 (47.2)
|
66 (52.8)
|
125 (100)
|
|
|
Occupation, n (%)
|
|
|
|
0.056[a]
|
|
• Employee
|
84 (53.5)
|
73 (46.5)
|
157 (100)
|
|
|
• Housewife
|
54 (72)
|
21 (28)
|
75 (100)
|
|
|
• Government officer
|
56 (51.9)
|
52 (48.1)
|
108 (100)
|
|
|
• Agriculture
|
7 (58.3)
|
5 (41.7)
|
12 (100)
|
|
|
• Other
|
109 (54.2)
|
92 (45.8)
|
201 (100)
|
|
|
Living place, n (%)
|
|
|
|
0.097[a]
|
|
• Nakhonnayok–Pathumthani
|
263 (57.7)
|
193 (42.3)
|
456 (100)
|
|
|
• Bangkok and others
|
47 (48.5)
|
50 (51.5)
|
97 (100)
|
|
|
Level of education, n (%)
|
|
|
|
0.412[a]
|
|
• Less than primary school–bachelor's degree
|
297 (55.7)
|
236 (44.3)
|
533 (100)
|
|
|
• Higher than a bachelor's
|
13 (65)
|
7 (35)
|
20 (100)
|
|
|
Maternal income, n (%)
|
|
|
|
0.358[a]
|
|
• Less than to 30,000 baht per month
|
297 (55.7)
|
236 (44.3)
|
533 (100)
|
|
|
• More than 30,000
|
13 (65)
|
7 (35)
|
20 (100)
|
|
|
Nulliparous, n (%)
|
|
|
|
0.123[a]
|
|
• Yes
|
232 (55)
|
190 (45)
|
422 (100)
|
|
|
• No
|
78 (59.5)
|
53 (40.5)
|
131 (100)
|
|
|
Nulligravida, n (%)
|
|
|
|
0.064[a]
|
|
• Yes
|
119 (52)
|
110 (48)
|
229 (100)
|
|
|
• No
|
191 (59)
|
133 (41)
|
324 (100)
|
|
|
History of abortion
|
|
|
|
0.554[a]
|
|
• Yes
|
99 (50.8)
|
96 (49.2)
|
195 (100)
|
|
|
• No
|
211 (58.9)
|
147 (41.1)
|
358 (100)
|
|
|
Gestational age, n (%)
|
|
|
|
0.036[a]
|
|
• First trimester
|
61 (58.7)
|
43 (41.3)
|
104 (100)
|
|
|
• Second to third trimester
|
249 (55.5)
|
200 (44.5)
|
449 (100)
|
|
|
Level of husband's education, only in with partner gr n (%)
|
|
|
|
0.897[a]
|
|
• Less than primary school– bachelor's degree
|
1 (0.4)
|
239 (99.6)
|
240 (100)
|
|
|
• Higher than bachelor's degree
|
0 (0)
|
4 (100)
|
4 (100)
|
|
|
Previous genetic counseling n (%)
|
|
|
|
0.062[a]
|
|
• Yes
|
278 (57.6)
|
205 (42.4)
|
483 (100)
|
|
|
• No
|
32 (45.7)
|
38 (54.3)
|
70 (100)
|
|
|
Preconceptional care, n (%)
|
|
|
|
0.771[a]
|
|
• Yes
|
194 (55.6)
|
155(44.4)
|
349 (100)
|
|
|
• No
|
116 (56.9)
|
88(43.1)
|
204 (100)
|
|
|
Previous child with anomaly or genetic disorder, n (%)
|
|
|
|
0.072
|
|
• Yes
|
15 (41.7)
|
21 (58.3)
|
36 (100)
|
|
|
• No
|
295 (57.1)
|
222 (42.9)
|
517 (100)
|
|
|
VAS attitude, median (Q1–Q3)
|
10 (9.5–10)
|
10 (9.4–10)
|
|
0.090[b]
|
|
VAS cost-effective, median (Q1–Q3)
|
10 (8.8–10)
|
10 (8.5–10)
|
|
0.097[b]
|
Abbreviations: Q, quartile; VAS, visual analogue scale.
a Mann–Whitney U-test.
b Chi-square test.
[Table 2] presents the ratio of the participants who had an overall knowledge score increase
and those who had no increase after the AGGC, according to the clinical factors. The
number of participants with an increased overall knowledge score was significantly
higher among those who attended the AGGC with their partner. [Table 3] presents the logistic regression analysis for factors that influenced ratio of the
participants who had an overall knowledge score increase and those who had no increase
after the AGGC. No variable apart from attending the AGGC with or without one's partner
was identified as influencing the ratio (crude OR: 1.605, 95% CI: 1.123–2.293, p = 0.009; adjusted OR: 1.564, 95% CI: 1.091–2.244, p = 0.015). Lastly, [Table 4] presents the comparison of median (Q1–Q3) of the overall knowledge score and the
scores categorized by each topic before and after AGGC, according to group with and
without partner's involvement. The medians (Q1–Q3) of the overall knowledge score
of all participants were 33 and 35 scores prior to and immediately after the AGGC,
respectively. The median of the knowledge score regarding trisomy-21 was the lowest
and did not improve after the AGGC.
Table 2
Ratio of the participants who have an overall knowledge score increase versus not
increase after antenatal genetic group counseling, according to the clinical factors
|
Factor
|
Not increase
|
Increase
|
Total
|
Prevalence rate ratio
|
95% CI
|
p-Value[a]
|
|
Group
|
With partner
|
72 (29.6)
|
171 (70.4)
|
243 (100)
|
1.179
|
1.043–1.333
|
0.009
|
|
Without partner
|
125 (40.3)
|
185 (59.7)
|
310 (100)
|
|
|
|
|
Religion
|
Buddhist
|
159 (37.1)
|
269 (62.9)
|
428 (100)
|
0.903
|
0.788–1.035
|
0.166
|
|
Muslim and others
|
38 (30.4)
|
87 (69.6)
|
125 (100)
|
|
|
|
|
Living place
|
Nakhonnayok–Pathumthani
|
164 (36)
|
292 (64)
|
456 (100)
|
0.971
|
0.828–1.137
|
0.717
|
|
Bangkok and others
|
33 (34)
|
64 (66)
|
97 (100)
|
|
|
|
|
Level of education
|
Less than a bachelor's degree
|
190 (35.6)
|
343 (64.4)
|
533 (100)
|
0.990
|
0.713–1.374
|
0.953
|
|
Higher than a bachelor's degree
|
7 (35)
|
13 (65)
|
20 (100)
|
|
|
|
|
Maternal income
|
Less than to 30,000 baht per month
|
156 (37)
|
266 (63)
|
422 (100)
|
0.917
|
0.800–1.052
|
0.237
|
|
More than 30,000
|
41 (31.3)
|
90 (68.7)
|
131 (100)
|
|
|
|
|
Nulliparous
|
Yes
|
74 (32.3)
|
155 (67.7)
|
229 (100)
|
1.091
|
0.964–1.235
|
0.172
|
|
No
|
123 (38)
|
201 (62)
|
324 (100)
|
|
|
|
|
Nulligravida
|
Yes
|
62 (31.8)
|
133 (68.2)
|
195 (100)
|
1.095
|
0.966–1.241
|
0.165
|
|
No
|
135 (37.7)
|
223 (62.3)
|
358 (100)
|
|
|
|
|
Abortion
|
Yes
|
38 (36.5)
|
66 (63.5)
|
104 (100)
|
0.983
|
0.866–1.196
|
0.829
|
|
No
|
159 (35.4)
|
290 (64.6)
|
449 (100)
|
|
|
|
|
Gestational age
|
First trimester
|
60 (31.6)
|
130 (68.4)
|
190 (100)
|
1.099
|
0.969–1.246
|
0.151
|
|
Second to third trimester
|
137 (37.7)
|
226 (62.3)
|
363 (100)
|
|
|
|
|
Previous genetic counselling
|
Yes
|
177 (36.6)
|
306 (63.4)
|
483 (100)
|
0.887
|
0.754–1.044
|
0.187
|
|
No
|
20 (28.6)
|
50 (71.4)
|
70 (100)
|
|
|
|
|
Preconceptional care
|
Yes
|
131 (37.5)
|
218 (62.5)
|
349 (100)
|
0.923
|
0.815–1.046
|
0.219
|
|
No
|
66 (32.4)
|
138 (67.6)
|
204 (100)
|
|
|
|
|
Previous child with anomaly or genetic disorder
|
Yes
|
9 (25)
|
27 (75)
|
36 (100)
|
1.179
|
0.965–1.439
|
0.169
|
|
No
|
188 (36.4)
|
329 (63.6)
|
517 (100)
|
|
|
|
a Chi-square test.
Table 3
Possible factors affecting an improved score after antenatal genetic group counseling
|
Factor
|
Crude OR
|
95% CI
|
p-Value
|
Adjusted OR[a]
|
95% Cl
|
p-Value
|
|
Maternal income
|
More than 30,000 baht per month
|
1.287
|
0.847–0.237
|
0.237
|
1.362
|
0.890–2.085
|
0.155
|
|
Less than to 30,000
|
1
|
|
|
1
|
|
|
|
Religion
|
Muslim and others
|
1.353
|
0.882–2.077
|
0.167
|
1.339
|
0.866–2.073
|
0.190
|
|
Buddhist
|
1
|
|
|
1
|
|
|
|
Group
|
With partner
|
1.605
|
1.123–2.293
|
0.009
|
1.564
|
1.091–2.244
|
0.015
|
|
Without partner
|
1
|
|
|
1
|
|
|
|
Nulligravida
|
No
|
1.299
|
0.897–1.879
|
0.166
|
1.253
|
0.862–1.820
|
0.237
|
|
Yes
|
1
|
|
|
1
|
|
|
Abbreviations: CI, confidence interval; OR, odds ratio.
a Adjusted with maternal income, level of maternal education, religion, group, history
of abortion, gestational age (trimester).
Table 4
Comparison of median (Q1–Q3) of the knowledge score before and after antenatal genetic
group counseling, according to group with and without partner's involvement
|
Without partner's involvement (n = 310)
|
With partner's involvement (n = 243)
|
|
Before
|
After
|
p-Value[a]
|
Before
|
After
|
p-Value[a]
|
|
Overall score
|
33 (30–36)
|
35 (32–39)
|
<0.001
|
32 (29–36)
|
36 (31–39)
|
<0.001
|
|
General knowledge
|
8 (7–8)
|
8 (7–9)
|
<0.001
|
7 (6–8)
|
8 (7–9)
|
<0.001
|
|
Ultrasonographic knowledge
|
6 (5–7)
|
7 (6–8)
|
0.008
|
6 (5–7)
|
7 (6–8)
|
<0.001
|
|
Trisomy 21 knowledge
|
6 (5–7)
|
6 (5–7)
|
0.279
|
6 (5–6)
|
6 (5–7)
|
0.002
|
|
Thalassemia knowledge
|
7 (6–8)
|
8 (6–9)
|
0.052
|
7 (6–8)
|
7 (6–9)
|
<0.001
|
|
Delivery knowledge
|
7 (5–8)
|
7 (6–8)
|
<0.001
|
6 (5–7)
|
7 (6–8)
|
<0.001
|
a Wilcoxon's signed-rank test.
Discussion
Patients' understanding of essential medical information is very important. A previous
study found that antenatal counseling enhanced pregnant individuals' obstetric knowledge
and their awareness of preventable complications related to pregnancy and childbirth.[4] Our study is the first to evaluate the influence of the partner's involvement in
AGGC on the knowledge score increase in Thailand, a developing country. We found that
pregnant women who attended the AGGC with their partner got higher scores. We hypothesized
that attending the AGGC with their partner may have reduced women's stress and could
be an indicator of other important factors like their overall support system. Minimized
stress may enhance one's ability to absorb new knowledge. Our finding is similar to
one relating to antenatal counseling regarding the human immunodeficiency virus (HIV).
That study found that couple-counseled pregnant individuals were more likely to accept
HIV testing than those who were counseled alone, and with no significant difference
in reported adverse events, including physical violence, divorce, and verbal abuse.
Moreover, compliance with antiretroviral drug prescription among the group counseled
as couples was better than among those who were counseled alone.[5] The effects of counseling on the partner's stress regarding pregnancy and childbirth
complications have been shown in a previous study.[6] There has also been a study of partners' involvement in such counseling in a rural
community in Tanzania. In that case, it was found that a small proportion of partners
had a good level of knowledge of obstetric danger signs, preparations for childbirth,
and readiness to deal with complications. Consequently, the community advocated the
partner's involvement in such counseling.[7]
The advantage of the present study is its focus on antenatal counseling. We included
several important antenatal topics. Enhanced knowledge will help pregnant individuals
and their family to make better decisions involving obstetric care in both the antenatal
and delivery stages. Moreover, our study included a new, updated questionnaire that
was carefully tested for validity, reliability, difficulty, and discrimination. However,
our study focused on a change in score by only 1 point and many not reflect less knowledge
but rather simple mistakes and may explain the lower score for some participants.
A greater change in the score may be more relevant for interpretation. Moreover, knowledge
in itself is not as important as how it can be applied by the pregnant individuals
to improve pregnancy outcome for both them and their babies. Higher knowledge score
on a questionnaire may not necessarily reflected better antenatal care decision. Our
study does not directly demonstrate this point. This is a disadvantage of our study.
Among the possible factors, only partner involvement influenced the overall knowledge
scores. This is in contrast to our previous study of counseling before second-trimester
genetic amniocentesis, where several factors were shown to influence the effectiveness
of second-trimester genetic amniocentesis counseling, such as the counseling methods,
the educational level of the pregnant individuals, and her previous experience with
genetic counseling.[2] The different of these findings may have resulted from the different of components
of knowledge between both studies and the counseling styles. Some topics, such as
general obstetric health care and delivery, may be too basic, depending on the patient's
educational level and experience with counseling. This is in contrast to a difficult
and complicated topic such as trisomy-21 screening. The knowledge score improvement
regarding trisomy-21 screening was limited among all the participants. It may be because
some pregnant individuals did not retain information about trisomy-21 screening if
it was not applicable in case of AGGC attended after they had undergone and/or declined
prenatal screening already. This result is similar to that of a previous study in
Thailand that found that most pregnant Thais have an inadequate knowledge of the trisomy-21
screening test. Though most of them had a positive attitude, their knowledge was very
limited especially before the education session or material provided.[8] Attention to other nonmeasured variables in the regression model that included maternal
income, religion, and nulligravida. We hypothesized that at present, Thai government
provided welfare support for pregnant women in Thailand in nearly all medical services
involving pregnancy. As a result, it could be reduced the participant's concern and
the biased perception of various information in need of payment. For religion, it
was very interesting and lucky for our country. Although there were the differences
of religion, but the lifestyle and various medical beliefs were quite similar whether
to fetal abnormalities screening and termination in cases of fetal malformation detected.
We believed that this reason could be explained the lack of effect of religion on
AGGC. Ultimately, despite any pregnancies, our pregnant women still concerned and
gave an importance to antenatal care. Thus, their perceptions of AGGC were not influenced
by their gravidity.
In regard to the counseling style, our study involved the group, face-to-face style
and PowerPoints presentation. This is different from a previous study that compared
video-assisted instruction (VAI) with the face-to-face method. In that one, it was
found that VAI was better in terms of knowledge improvement, time consumption, and
cost saving.[9] The top advantage of VAI is repeatability without staff input required. Based on
our finding, we recommend that the partner should be invited to the AGGC session.
Attention on the topic presentation sequence, the standardized presentation performed
with same script and same topic sequence (in order of general knowledge, ultrasonographic
knowledge, trisomy-21 knowledge, thalassemic knowledge, and delivery knowledge topic).
The sequence of presentation may have influenced the pregnant individuals' knowledge
score in each topic. Our study did not evaluate this. It was a limitation of our study
and planned a further study. Regarding the question and answer at the end of AGGC
session, it was possible to be a confounding among session. Anyway, most of our participants
did not ask any question accompanies with our randomly appointed the participant (similar
to cluster sampling) into the AGCC with unknown of their partner's involvement status.
Thus, we thought that the effect was too low until we did not analyze the result per
session.
Conclusion
We have shown that partner's involvement is a factor in associating pregnant individuals'
scores. Also, their knowledge of trisomy-21 screening got the lowest score among the
survey topics. This needs to be focused on and improved.
What's Already Known?
What Does This Study Add?
-
Partner's involvement in the antenatal genetic group counseling (AGGC) positively
influenced the ratio of the participants who had increased their overall knowledge
score when comparing the scores prior to and immediately after the AGGC with participants
who had attended without their partner.
-
Knowledge of trisomy-21 screening in most pregnant Thais was very limited, especially
before the education session and also less improvement when compared with other survey
topics such as ultrasonographic, thalassemia, and delivery topics.
How This Study Could Improve Clinical Practice?
